What is Depression?

Everyone gets depressed at some time or another to varying degrees. Although often labeled as just sadness, depression can be a normal reaction to various events that occur in your life. Just as there are many types of losses, there are many causes for depression. While clinical depression is officially defined as lowered affect in the absence of externally attributable causes, the term “depression” is used by lay people and health professionals as well to describe a large continuum of symptoms and their impact on one’s daily life. Whether you know the cause or not, going through a depression is a difficult and challenging period.

It is important to stress the fact that depression can be a natural response to these negative life events and is normally a transient mental state that will be resolved. Those who experience long-term depression however may find that their immune system is weakened. As a result, these people are less likely to be able to fight off infections and cancers. It is important then to try to heal depression so that health and immunity will be restored.

In surveying discussion groups on the Internet, I found that one of the busiest newsgroups was the support group for depression. On my own website which provided information on a variety of mental health topics, depression was the most frequently accessed topic. In the newsgroup, people exchanged information on medication, side effects, signs of depression, and things that facilitated the resolution of a depression. Many provided encouragement for others, and for some it was a chance to express themselves. The number of postings to this group gives an indication of the number of people who are affected at the same time by depression. These individuals report lowered spirits, a loss of self-esteem, difficulty sleeping, and a difference in their everyday perspective. Other symptoms may include a loss of energy, weight loss or gain, changes in appetite, and physical complaints without any medical basis. Depressed people have also been shown to differ in the processing and anticipation of pain: They often demonstrate a hyper-vigilant response to anticipated pain and an inhibited ability to modulate the experience of pain.

Depression can be severe and challenging. Diagnosis is sometimes elusive. Andrew Solomon writes: “Depression is a condition that is almost unimaginable to anyone who has not known it. A sequence of metaphors–vines, trees, cliffs, etc.–is the only way to talk about the experience. It’s not an easy diagnosis because it depends on metaphors, and the metaphors one patient chooses are different from those selected by another patient.”

According to the World Health Organization, “Depression is a common illness worldwide, with an estimated 350 million people affected. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when long-lasting and of moderate or severe intensity, depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school and in the family. At its worst, depression can lead to suicide. Suicide results in an estimated one million deaths worldwide every year.”

In a recent Twitter campaign, Twitter users describe the worst part of depression. Here are some of the tweets:

feeling an overwhelming pressure to mask it, to pretend it isn’t debilitating. It is exhausting.

the waiting… waiting inside my broken head for it to go away and not knowing if it will outlast me.

feeling like a prisoner in your own mind, while the world thinks you’re “a little bummed out.”

my mind telling me that I’m lazy and pathetic because I have no motivation to do anything.

the physical pain that most people don’t talk about. Depression HURTS.

Clearly coming out of a depression can be a re-awakening, but the corridors of depression can seem long, dark and empty. Depressed people are often withdrawn. It is now understood that there are fundamental changes in brain function of depressed people. In one study, researchers observed that their brain activity was out of sync in the region that processed feelings of hatred. It is important to note that, although the feelings of hatred were suppressed, feeling more hatred would not be a helpful or positive step towards healing. Furthermore, depressed people may have a reduced ability to cope with and learn from daily life.

In her Tedtalk, violinist Ji-Hae Park describes the deep feeling of despair: “Although many people tried to comfort and encourage me, their words sounded like meaningless noise.” I encourage you to go to YouTube and watch her inspiring video in which she describes how the power of music gave her comfort in the midst of her hardship, and restored her soul.

The Metaphors of Depression

It is important to understand the metaphors used to describe depression. I learned from Sonya Pritzker that in Chinese culture, the symbol of two trees is used to represent depression. Sonya has written an excellent article titled The Role of Metaphor in Culture, Consciousness and Medicine. We met while I was visiting a Buddhist temple in Beijing where she was volunteering for a survey on depression. Her article describes how the symbol of two trees represents a forest. From within a thick forest, you can feel the sense of darkness, being unable to see a path, a canopy of growth blocking the light, and an inability to move freely because of the thick growth. Other metaphors she describes include falling down, darkness and lack of control. Sonya writes:

“The concepts of darkness, lack of movement, and falling down can all be subsumed under the conceptual metaphor ‘Depression is Down.’ Being down is associated with sleep, or darkness, and when we are down, as in for sleep or rest, we are not moving. The journey that is life is restricted when we do not, or cannot, move… Depression in the English language has many meanings. The American Heritage Dictionary (1992) lists nine definitions of depression, only one of which is the formal psychological definition. Another describes a similar condition of ‘sadness or despair’. Others include ‘an area that is sunk below its surrounding; a hollow’, ‘a reduction in physiological vigor or activity’; and ‘a period of drastic decline in national or international economy’, among others. Clearly, the metaphorical implications in these definitions point to the understanding in English-speaking culture of depression as a lack of activity, a state of being below or less than normal.”

While we often think of depression as “feeling down”, it can also manifest itself in a raised state of energy. Sonya writes: “the clinical definition also includes symptoms one might not expect to see if metaphorical thinking were restricted to the notion of being ‘down.’ The symptoms are more restless, and include possible increase in appetite, insomnia, psychomotor agitation, and suicidal plans or thoughts. These symptoms point more towards the ‘lack of control’ metaphor.”

Sonya makes a good point about the individual experience of depression when she writes:

“The diagnostic guidelines…stipulate that an individual suffering from five or more of the above nine symptoms for a two week period or longer is clinically depressed. This makes it possible for each suffering individual to manifest differently, but within certain bounds. The conceptual metaphors implicated in the clinical definition are thus relatively flexible, allowing for the emotions associated with sadness, fear, and anxiety to manifest to varying degrees in depression.”

Causes of Depression

Just as there are many definitions for depression, it seems that depression can result from many factors. Any process of change (such as growing up) involves transformation and transition. Depression can occur as a result of a loss, a success, achieving a goal, a physical injury, a personal trauma, or simply as a result of a build-up of daily events. Change of any type, be it geographical location, lifestyle, work, daily routine or contact with others can be a contributing factor in depression. Any loss of someone or something of value can be a catalyst for depression.

Other causes of depression can include:

-a process of transition
-poor thinking patterns
-lack of direction in life
-achieving adulthood
-discovering that life isn’t measuring up to what you would like it to be
-unresolved grief
-a sense of helplessness
-an unfulfilling job
-beliefs you hold about yourself that keep limiting your self-esteem

One of the causes of depression in adult children is a sense of learned helplessness. You may have grown up in a family in which you did not have any power to effect change in your situation. For years it seemed as though you had to accept the decisions and behaviors of others, and that nothing you did mattered. This ongoing situation tends to instill a sense of helplessness later in life. One of the ways out of depression is to identify areas in which you can make changes. Fortunately, the helplessness is only a learned behavior. It can be replaced with the new attitude that you can make positive changes in your life.

According to Traditional Chinese Medicine (TCM), depression is referred to as a form of stagnation – a restricted flow or obstruction. Symptoms of this stagnation include over-attachment, preoccupation with fears, being unable to let go, and somatic symptoms arising from challenging emotions. Depressed people may also experience heightened awareness and uneasiness that manifest as inhibited facial expressions, emotion and movement. I can relate to this definition. In my early twenties I experienced a profound depression. Each time I cried, I found that my facial expression increased and I felt freer. Others noticed that I was smiling more often and was more expressive.

Depression can also be caused by rumination. Often a feeling of sadness or hurt will be created by repeatedly reviewing feelings of hurt from the past without an increase in knowledge or understanding. Depression may also result from a lack of short-term goals. There is an Irish proverb that says: “You don’t plow a field by turning it over in your mind!” While some evaluation is necessary, too much rumination can lead you into a spiral of self-absorption rather than being able to see the world around you.

Long-term depression can be the result of problems in a person’s thinking and attitudes, while unresolved issues and trauma can prolong sadness resulting from the event. People who have avoided feelings or who are suffering from a significant loss may be characterized as depressed, yet it is grieving work that the individual may need to complete to resolve the sadness. In some cases, the events may be difficult to identify because the person has avoided their feelings and has not become appropriately and sufficiently upset by the events. A chronic feeling of sadness may also be indicative of the fact that certain areas of a person’s life need changing. Some people may have an unsatisfying job or difficulties relating to others. Without resolution or positive change, the sadness will be an ongoing component of their lives. In the cases of earlier abuse, the depression may be the result of a wound to the individual’s character or soul, which requires a process of grieving, self-acceptance and healing to resolve the depression.

From the above, we can conclude that the causes of depression are numerous. As well, there are some generalities about depression that should be examined. Depression has sometimes been described as anger turned inwards, but it is not fair to say that all depressions are the result of unexpressed anger. In labeling the depression as a disease, some may feel powerless to resolve the depression but there is much that can be done. As research continues to explore and demonstrate through the use of “healthy pleasures” such as singing, meditation, yoga, and physical exercise, it is possible to naturally restore the brain to its optimal level of physiological health.

The Secret Strength of Depression

Life itself often involves re-evaluating our beliefs and values. The process of developing these values may seem like a depression. Each transition or change involves letting go of something and accepting something new. In The Secret Strength of Depression, Dr. Frederich Flach writes: “in order to move successfully from one phase to the next, a person must be able to experience depression in a direct and meaningful way.” There was a period after completing my master’s degree that I entered a very deep depression. I felt overwhelmed by the level of student debt I was carrying, and the financial difficulties that came with it, while at the same time re-establishing my social life. Through the process of feeling and working through my depression, I learned how shaky my faith was in trusting that things would work out, and realized that despite feeling lonely, I had a number of friends who cared deeply about me. I also let go of some friendships that were not serving me. It became a time of cleaning house. I was having a recurring dream of kittens being discovered in the basement who had gone undetected for some period of time. As I moved through my depression and made sense of the fact that I had some new lessons to learn, the kittens became healthier and healthier in my dream each time I rediscovered them. While it took some time to work through this, I made great progress in learning that I needed to help myself.

One of the drawbacks to our current description of depression is that many professionals do not differentiate between depression and ongoing sadness as a result of unresolved grief or loss. The term depression is a wide, sweeping term used to describe a condition that has numerous causes. Just as the Eskimos have over thirty different words for types of snow, it would be helpful to expand the range of words to describe depression. Growing up in a cold northern climate, I know that there really are different types of snow: light flakes, heavy flakes, packed snow, wet, sticky, slushy, crunchy, and ice covered. Powdery snow is what the avid skiers love but it is usually only found at the highest peaks! Perhaps we can all learn to be more detailed in describing depression. Here are just a few words to help you be more specific. Which words might you use to describe the sensation of depression?

Although depression reduces vitality and makes it difficult to find solutions to problems, there are benefits to depression. Often, creative people will attribute the creation of their work to an episode of depression. Many individuals who have made significant life changes also attribute the changes they made to periods of depression. As Dr. Flach writes: “to experience acute depression is an opportunity for a person not just to learn more about himself, but to become more whole than he was. Not only does depression afford a chance for insight, but ‘falling apart’ can accelerate the process of reordering one’s life after a serious stress.”

Often these people will emerge from a depression with a new and exciting view of life. Similar to the idea of the phoenix that crashes into the fire yet emerges as a beautiful new bird, a depression that is experienced and resolved allows us to rebound to new levels of understanding and meaning. Dr. Flach writes: “to be creative in any sense, a person must be able to relinquish old and fixed assumptions that block a fresh appraisal of a situation.” Perhaps to be creative also involves being open to the experience of moving through a depression.

Although hard to envision when depressed, according to Buddhist teacher Chogyam Trungpa Rinpoche:

“Depression is the most dignified energy of all…Depression is one of the very powerful energies, one of the most common energies that we have. It is energy. Depression is like an oxygen tank which wants to burst, but is still bottled. It is a fantastic bank of energies, much more so than aggression and passion which are kind of developed and then let out… Depression is not just a blank, it has all kinds of intelligent things happening within it. I mean, basically depression is extraordinarily interesting and a highly intelligent state of being. That is why you are depressed. Depression is an unsatisfied state of mind in which you feel that you have no outlet. So work with the dissatisfaction of that depression. Whatever is in it is extraordinarily powerful. It has all kinds of answers in it, but the answers are hidden. It is extraordinarily awake energy, although you might feel sleepy… Things get very heavy and very slow…Meeting inspiring friends, who used to be inspiring friends, becomes depressing. When you try to put on…music that used to inspire you, it also brings depression. Still nothing ever moves. The whole thing is black, absolute black.”

By watching the Tedtalk by violinist Ji-Hae Park on Youtube, you can observe firsthand how depression can be turned into creativity. Ji-Hae Park expanded her creativity and embarked on a new personal music style. She found new meaning in music and began a journey of helping others.

Having experienced depression at various times, I am aware of the stigma that can sometimes be attached to depression. Perhaps as a society we need to challenge our view of mental health and depression. Society has generally viewed the happy-go-lucky person as the well-adjusted person. Now we are gaining the understanding that episodes of depression are a natural part of life and growth. Perhaps the person who gets angry, cries, laughs or gets embarrassed, and who works through a depression, is the well-adjusted person. One article I read suggested that the outcome of trying to eliminate the symptoms of depression was to pathologize normal adaptive responses to stress. In an Internet posting on the topic of depression, an individual posed the question “When will I be normal again?” Perhaps a better line of reasoning might be “I am depressed. I am normal. How long will this last? What can I do to take care of myself?”